Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Amendment to the Agreement with CEP America - California, a California General Partnership d/b/a/ Vituity for Emergency and Correctional Health Services
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the County’s agreement with CEP America - California, a California General Partnership dba Vituity to extend the term of the agreement by three months through June 30, 2026, and increase the amount of the agreement by $690,790, to an amount not to exceed $8,935,126.
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BACKGROUND:
Vituity provides physicians, midlevel practitioners (also known as “advanced practice practitioners”), and scribes to provide professional medical and medical administrative services in San Mateo Medical Center (SMMC)’s emergency department and Correctional Health Services (CHS) at the County Jail. The County’s initial agreement with Vituity encompassed a term of April 1, 2023 through March 31, 2026 in an amount not to exceed $8,219,336. On May 1, 2023, the parties amended the agreement to add flexibility to the scheduling of physician services at CHS and to expand the scope of services provided by Vituity’s Medical Director for Emergency Medicine. On September 3, 2025, the parties entered into a second amendment to the agreement, adding $25,000 to the “not to exceed” amount to provide for additional Epic “Super User” support services, thereby increasing the “not to exceed” amount from $8,219,336 to $8,244,336.
DISCUSSION:
The proposed amendment would extend Vituity’s contract for emergency department and CHS coverage by three months and proportionately increase the “not to exceed” amount by $690,790 to ensure that the agreement’s coverage and medical administrative services continue unabated for an extended term of April 1, 2023 through June 30, 2026 in an amount not to exceed $8,935,126. The amendment is sought to facilitate contract renewal negotiations.
The County Attorney has reviewed and approved the resolution and agreement as to form.
The resolution contains the County’s standard provisions allowing amendment of the County fiscal obligations by a maximum of $25,000 (in aggregate).
It is anticipated that 98% of patients who leave the emergency department would have been seen by a physician. This is a standard measure of operational efficiency in emergency departments, and this target represents a high level of service.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-2025 Actual |
FY 2025-2026 Estimated |
|
Percentage of patients that leave the emergency department that have been seen by a physician |
98% |
98% |
COMMUNITY IMPACT:
Vituity’s continued emergency department and correctional health coverage is necessary to maintain continuity of legally required services at SMMC, a public safety net hospital and to addresses community need. SMMC’s patients span a wide spectrum of races, ethnicities, gender, and gender-identities. Since November 1, 2024, SMMC has cared for equal cohorts of male and female patients, while the largest ethnic cohorts were Hispanic or Latino (58%) who were primarily Spanish speaking (48%). SMMC strives to eliminate bias in the medical profession by providing culturally competent training to its physicians and by following up with patients to ensure that they continue to have access to specialized care. SMMC specifically tracks physician satisfaction survey results and requires Vituity to meet with SMMC and discuss patient feedback to improve patient satisfaction and remove potential barriers to care.
FISCAL IMPACT:
The extended term of the agreement is April 1, 2023 through June 30, 2026. The amount of the agreement is not to exceed $690,790 for the three-month extended term. Funds in the amount of $562,292 are included in the SMMC FY 2025-26 Adopted Budget. Funds in the amount of $128,498 are included in the CHS FY 2025-26 Adopted Budget. Similar arrangements will be made for future years if further extensions into the 2026 fiscal year are necessary.
The payment provisions and levels of services in the contract remain unchanged during the extension period.
Expenses at SMMC are covered by fees for services or third-party payors whenever possible. The portion of expenses for services provided to the medically indigent or to those covered by programs that do not meet the full costs of care is covered by the County’s General Fund contribution to SMMC and is within the existing annual appropriation.